Democratic gains mark setback for Trump on Medicaid work requirements

Democratic gains mark setback for Trump on Medicaid work requirements
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Democratic victories in Tuesday’s elections marked a significant setback for the Trump administration’s efforts to impose Medicaid work requirements at the state level.

By flipping the legislature in Virginia, coupled with an apparent win in Kentucky’s gubernatorial race, Democrats can now block GOP plans to tie Medicaid benefits to employment.


“In my first week in office, I’m going to rescind this governor’s Medicaid waiver,” Andy Beshear (D), who has claimed victory in the Kentucky governor’s race against incumbent Matt Bevin (R), told supporters Tuesday night. 

“Health care is a basic human right and my administration will treat it as such.”  

The Trump administration’s Department of Health and Human Services (HHS) has approved work requirement programs in nine states, including Kentucky, arguing that employment improves health and promotes self-sufficiency. 

But opponents argue the requirements create administrative hurdles to health care for low-income adults, many of whom are already working.  

Kentucky’s requirements are not in effect after being blocked by a federal judge twice, but Bevin has vowed to appeal the case all the way up to the Supreme Court. 

Beshear made the issue a key part of his campaign, vowing to protect the state’s Medicaid expansion, which extended coverage to 400,000 low-income adults. 

Bevin’s program would have required most of those people to prove they are working, volunteering or attending school 20 hours a week to retain their benefits, potentially reducing Medicaid rolls by 95,000, according to state estimates. 

As governor, Beshear can pull the state out of the program, said Robin Rudowitz, co-director of the Kaiser Family Foundation’s program on Medicaid and the uninsured. 

“New governors do have the authority to not implement or to rescind a waiver from a prior administration,” Rudowitz said.  

Democrats also won control of the Virginia legislature Tuesday night, paving the way for Gov. Ralph Northam (D) to scrap the state’s proposed work requirements.  

Northam succeeded last year in getting the Republican-controlled state legislature to pass Medicaid expansion, extending coverage to 400,000 low-income adults.  

But Republicans only supported the expansion on the condition that the state seek approval from the Trump administration to impose work requirements on that population. The requirements haven’t taken effect and are still being negotiated between HHS and the Northam administration.  

Democratic victories Tuesday likely mean the party will have the votes next year to remove those requirements. 

“The governor is looking at all options moving forward — it's pretty clear from the results last night that Virginians want more access to healthcare, not less,” Northam's office told The Hill on Wednesday. 

Medicaid has proved to be a top issue in recent elections, particularly in red states. 

Voters in Utah, Idaho, Nebraska and Maine approved ballot initiatives to expand Medicaid to cover more low-income adults, despite yearlong opposition from the states’ Republican leaders. 

Similar efforts are underway to get Medicaid expansion on the ballot in Oklahoma and Missouri. 

“This continues a trend we have seen in recent elections where Medicaid has a lot of support at the ballot box across political parties,” Joan Alker, executive director of the Center for Children and Families at Georgetown University.  

“It’s really remarkable how important Medicaid expansion has become as an issue in red states. And the voters want it.” 

Thirty-six states and Washington, D.C., expanded Medicaid to cover more low-income adults under ObamaCare. 

But lawmakers in Republican-led states looking to curtail rising health care spending have turned to work requirements as a way to trim Medicaid rolls. 

In Arkansas — the only state where work requirements have taken effect, before being blocked in court — 18,000 people lost coverage. 

Overall, the administration’s work requirements have not fared well: None of the programs are in effect, but Michigan and Ohio are planning to begin implementation in 2020 and 2021. 

A federal judge also blocked the program in New Hampshire. Indiana and Arizona have had their programs approved but put implementation on hold as courts block the requirements in other states. 

Meanwhile, Democrats argue that their success at the polls Tuesday is a further sign that voters trust their party more on health care heading into 2020. 

“Health care remains the dominant issue in politics today,” said Geoff Garin, a leading pollster for the Democratic Party.

“We saw that play out in Kentucky last night and we think there is good potential for it to play out in similar ways across the country in 2020 democrats put that issue front and center as Andy Beshear did in Kentucky.”